Inpatient Medical Director for Cigna-Medicare Advantage
As most of you are aware, the number of COVID19 cases has started to increase dramatically within the last week or so. In our routine utilization meeting, several things have come to light.
Concerning our own patients’ health, it is probably in their best interest if we try to keep them out of the emergency room. Please make sure your patients have access to healthcare. If the patient needs to be in the hospital, you can direct admit them from your office to the appropriate level of care and avoid the ER.
From a cost perspective, our patients are much more likely to be admitted (not observation), placed in acute long-term care, or the rehabilitation unit. Because of emergency rules applied during the COVID19 crisis, case management has very little to do with where our patients go. Therefore, the patients are much more likely to end up in an inappropriate level of care, regardless of the care they actually need. This is not only potentially generating higher patient out-of-pocket costs, but is also actually costing the health plans quite a bit and will ultimately impact our bonuses. If you can see these patients in the office, then you can refer them to SNF, direct admit(do not forget to do a prior auth.), or observation if you deem appropriate. This will be greatly reducing the unnecessary short length of stays which are costly, possibly unnecessary, and exposing our patients to infections in the hospital.